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Study of Lenalidomide in Patients With Acute Myeloid Leukemia or High Risk Myelodysplastic Syndrome

Primary Purpose

Acute Myeloid Leukemia, Myelodysplastic Syndrome

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Lenalidomide
Sponsored by
University of California, Davis
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring Bone marrow transplantation, Maintenance lenalidomide

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Understand and voluntarily sign an informed consent form
  • Age greater than or equal to 18 and less than or equal to 65 years
  • Able to adhere to the study visit schedule and other protocol requirements.
  • High risk acute myelogenous leukemia or high risk myelodysplastic syndrome status post allogeneic bone marrow transplant
  • ECOG performance status of less than or equal to 2
  • Disease free of other malignancies beside the AML or MDS for ≥ 2 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast.
  • All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®.
  • Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days and again within 24 hours prior to prescribing lenalidomide for Cycle 1 (prescriptions must be filled within 7 days as required by RevAssist) and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy.
  • Between 6 months to 8 months post transplant
  • Laboratory tests:
  • Neutrophil count of ≥ 1.5 x 109/L
  • Platelet count ≥ 50 x 109/L
  • Calculated creatinine clearance ≥ 60ml/min by Cockcroft-Gault formula
  • Total bilirubin ≤1.5 x upper limit of normal
  • AST (SGOT) and ALT (SGPT) ≤ 3 x upper limit of normal

Patients are eligible to start on this protocol if they are between 6 months to 10 months post transplant.

Exclusion Criteria:

  • Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form
  • Pregnant or breast feeding females (Lactating females must agree not to breast feed while taking lenalidomide)
  • Any level of acute graft versus host disease
  • Active, uncontrolled infection are not eligible for this study
  • Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study
  • Use of any other experimental drug or therapy within 28 days of baseline.
  • Known hypersensitivity to thalidomide
  • Development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drug
  • Known sero-positive for active viral infection with HI, hepatitis B virus (HBV) or hepatitis C virus (HCV)
  • Mixed chimerism (at 6 months post transplant will not be started on the protocol
  • Active AML or MDS at the time of the study are not eligible for this protocol
  • Not able to swallow the lenalidomide capsule as a whole are excluded from this study
  • Impaired gastrointestinal absorption

Sites / Locations

  • University of California Davis

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Phase I Dose Escalation

Arm Description

Subjects are given a single dose of the drug while they are observed and tested for a period of time. If they do not exhibit any adverse side effects the dose is escalated, and a new group of subjects is then given a higher dose.

Outcomes

Primary Outcome Measures

Maximum-tolerated dose as assessed by NCI CTCAE, Version 4.0 and Graft versus Host Disease Staging
All patients will be followed closely and evaluated for toxicity. For grade III-IV non hematological toxicity or grade IV hematological toxicity associated with lenalidomide will be held until the toxicity resolves and then will be started at a lower dose; Patients who develop grade II to IV GVHD on study will stop lenalidomide

Secondary Outcome Measures

Disease relapse
Percentage of patients with relapse from all the patients who received the transplant.
Disease-free survival
Percentage of patients who are alive and remain in remission at one year after infusion of stem cells
Incidence of Graft versus Host disease
The percentage of pathologically confirmed cases of acute and/or chronic Graft versus Host disease at one year post transplant

Full Information

First Posted
September 12, 2011
Last Updated
March 8, 2022
Sponsor
University of California, Davis
Collaborators
Celgene
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1. Study Identification

Unique Protocol Identification Number
NCT01433965
Brief Title
Study of Lenalidomide in Patients With Acute Myeloid Leukemia or High Risk Myelodysplastic Syndrome
Official Title
Phase I Trial of Maintenance Lenalidomide in Patients With Acute Myeloid Leukemia or High Risk Myelodysplastic Syndrome Post Allogeneic Bone Marrow Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
August 8, 2012 (Actual)
Primary Completion Date
June 12, 2018 (Actual)
Study Completion Date
January 12, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of California, Davis
Collaborators
Celgene

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine whether lenalidomide can stop the growth of leukemia stem cells and can be used to prevent the return of leukemia cells after a transplant.
Detailed Description
The purpose of this study is determine whether lenalidomide can directly inhibit leukemic stem cells in vivo and can be used to prevent the relapse of leukemia stem cells after transplant. A concern with any post transplant intervention is the possibility of multiple drug interactions, potential for graft versus host disease exacerbation and/or induction of cytopenia. Therefore, the smallest doses of lenalidomide (5 mg) that has been used in this setting will be utilized as dose level 1. Starting six months post-transplant, patients will begin on a daily dose of lenalidomide. Dependent on the cohort, patients will receive 5 to 20 mg of lenalidomide post transplant. The maximum tolerated dose (MTD) will be determined by the incidence of grade III-IV toxicities of all organs and grade II-IV GVHD. Duration of treatment is six months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia, Myelodysplastic Syndrome
Keywords
Bone marrow transplantation, Maintenance lenalidomide

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Phase I Dose Escalation
Arm Type
Experimental
Arm Description
Subjects are given a single dose of the drug while they are observed and tested for a period of time. If they do not exhibit any adverse side effects the dose is escalated, and a new group of subjects is then given a higher dose.
Intervention Type
Drug
Intervention Name(s)
Lenalidomide
Other Intervention Name(s)
REVLIMID, CC-5013
Intervention Description
Lenalidomide will be taken orally once a day for 21 days continuously in 28 day cycles. The dose of the lenalidomide administered to each patient will be based on the group that the patient is enrolled. The dose cycles will be 21 days of a 28 day cycle.
Primary Outcome Measure Information:
Title
Maximum-tolerated dose as assessed by NCI CTCAE, Version 4.0 and Graft versus Host Disease Staging
Description
All patients will be followed closely and evaluated for toxicity. For grade III-IV non hematological toxicity or grade IV hematological toxicity associated with lenalidomide will be held until the toxicity resolves and then will be started at a lower dose; Patients who develop grade II to IV GVHD on study will stop lenalidomide
Time Frame
4 week cycle; the expected time frame is 24 weeks (or 6 cycles)
Secondary Outcome Measure Information:
Title
Disease relapse
Description
Percentage of patients with relapse from all the patients who received the transplant.
Time Frame
One year
Title
Disease-free survival
Description
Percentage of patients who are alive and remain in remission at one year after infusion of stem cells
Time Frame
One year
Title
Incidence of Graft versus Host disease
Description
The percentage of pathologically confirmed cases of acute and/or chronic Graft versus Host disease at one year post transplant
Time Frame
One year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Understand and voluntarily sign an informed consent form Age greater than or equal to 18 and less than or equal to 65 years Able to adhere to the study visit schedule and other protocol requirements. High risk acute myelogenous leukemia or high risk myelodysplastic syndrome status post allogeneic bone marrow transplant ECOG performance status of less than or equal to 2 Disease free of other malignancies beside the AML or MDS for ≥ 2 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast. All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®. Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days and again within 24 hours prior to prescribing lenalidomide for Cycle 1 (prescriptions must be filled within 7 days as required by RevAssist) and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. Between 6 months to 8 months post transplant Laboratory tests: Neutrophil count of ≥ 1.5 x 109/L Platelet count ≥ 50 x 109/L Calculated creatinine clearance ≥ 60ml/min by Cockcroft-Gault formula Total bilirubin ≤1.5 x upper limit of normal AST (SGOT) and ALT (SGPT) ≤ 3 x upper limit of normal Patients are eligible to start on this protocol if they are between 6 months to 10 months post transplant. Exclusion Criteria: Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form Pregnant or breast feeding females (Lactating females must agree not to breast feed while taking lenalidomide) Any level of acute graft versus host disease Active, uncontrolled infection are not eligible for this study Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study Use of any other experimental drug or therapy within 28 days of baseline. Known hypersensitivity to thalidomide Development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drug Known sero-positive for active viral infection with HI, hepatitis B virus (HBV) or hepatitis C virus (HCV) Mixed chimerism (at 6 months post transplant will not be started on the protocol Active AML or MDS at the time of the study are not eligible for this protocol Not able to swallow the lenalidomide capsule as a whole are excluded from this study Impaired gastrointestinal absorption
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mehrdad Abedi, MD
Organizational Affiliation
University of California, Davis
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California Davis
City
Sacramento
State/Province
California
ZIP/Postal Code
95817
Country
United States

12. IPD Sharing Statement

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Study of Lenalidomide in Patients With Acute Myeloid Leukemia or High Risk Myelodysplastic Syndrome

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